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Personalised care for pancreatic cancer

Comprehensive team approach

What is pancreatic cancer?

Pancreatic cancer occurs when malignant cells develop in part of the pancreas and grow into a tumour. Tumours can occur in any part of the pancreas, but about 70% of pancreatic cancers are located in the head of the pancreas.  Pancreatic cancer cells can also spread to nearby lymph nodes (part of the immune system), blood vessels or nerves. Cancer cells may travel through the bloodstream to other parts of the body, such as the liver.

What is the treatment strategy?

It is critical to develop a personalised treatment strategy for each individual.  In broad terms, the treatment starts by staging the spread of the cancer.  This is done by performing scans including CT scans and FDG PET scans as well as a staging laparoscopy.  A staging laparoscopy is a small operation where a camera is put inside the abdomen to exclude occult spread of the cancer that may be missed by scans.

Once the staging has been completed, we then move onto treatment.  This would normally involve a team approach between Dr Mittal and an oncologist who Dr Mittal will recommend for you.  If the cancer is locally advanced, the first phase of the treatment is called neo-adjuvant chemotherapy.  This is when chemotherapy is given to the patient before the operation to shrink the tumour and treat any cells that may have spread beyond the pancreas.  Once neo-adjuvant chemotherapy has been completed, Dr Mittal will then aim to perform a resection of the pancreatic cancer.  After recovery from the operation, the patient will then be given further adjuvant chemotherapy to finish the treatment. In some cases, Dr Mittal may recommend that the patient be also given radiotherapy to the resection margins.

If the cancer is small and localised without involving any of the major vessels around the pancreas, then it may be appropriate for Dr. Mittal to remove the cancer with an operation and then give six months of adjuvant chemotherapy. 

It is important to chose the right team to treat your pancreatic cancer.  Dr Mittal is an experienced and highly qualified pancreatic surgeon.  Dr Mittal has helped patients across the lower North Shore of Sydney and surrounding areas as well as patients traveling from different cities. He is also one of the founding members of the Australian Pancreatic Centre.  Dr Mittal works with a tight knit team of doctors and dieticians who will help you get through your treatment.  Dr. Mittal supervises the Pancreatic Exocrine Insufficiency clinic at RNSH - this clinic is dedicated to monitoring and treating the effects of not having a part of your pancreas after the operation.

Dr. Mittal is skilled in both open, robotic and laparoscopic (key hole) surgery of the pancreas. He routinely undertakes complex pancreatic resections including resecting the portal vein if required to completely remove the cancer. These operations are performed at North Shore Private Hospital, Macquarie University Hospital  and Royal North Shore Hospital.

Here is a recent news-paper article mentioning the work done by Dr. Mittal: Lighting the way in toughest of fights

What Are The Specific Procedures For Pancreatic Cancer?


Pancreatic surgery comprises of a wide range of surgical procedures. Some of the commonly performed pancreatic surgeries include:

  • Whipple Procedure: Also known as pancreatoduodenectomy, is performed to treat cancers at the head  of the pancreas. During the procedure, the head of the pancreas, the gallbladder, duodenum, a part of the bile duct, and sometimes a part of the stomach are removed. The remaining bile duct, intestine, and pancreas are then reconnected so that pancreatic enzymes, food and bile can flow back into the intestines.

  • Distal pancreatectomy is usually performed when the cancer is found in the middle or tail end of the pancreas. The spleen may need to be removed during this operation as well to ensure removal of all the cancer cells. 

  • Total pancreatectomy and splenectomy is occasionally performed when removal of the entire pancreas is required to remove the pancreatic cancer.


After surgery, Dr Mittal will follow your progress closely with CT scans and blood tests at regular intervals. This close follow up period that spans many years will ensure that if there is a recurrence of the pancreatic cancer, it is picked up early and treated appropriately.

Our professional care


When you contact our clinic, know you are receiving the highest medical care available. Dr Mittal is a leader in his field, passionate about research and sharing his extensive medical knowledge with his peers.  Dr. Mittal runs a research program in pancreatic cancer research based at the Bill Walsh Laboratory.



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